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The Società Lavorazioni Organiche Inorganiche (SLOI) in Trento (North-Eastern Italy) produced tetraethyl lead from 1941 to 1978, when it was closed following an explosion, luckily with no fatalities. Working conditions were very bad. During the 1960s, 325 acute lead intoxications were reported and over 100 workers were hospitalized for neurological conditions attributable to tetraethyl lead. At least 12 SLOI workers were hospitalized in the mental asylum (psychiatric wards).The present work describes the first formal epidemiological study ever carried out on SLOI workers. In the absence of any original SLOI employee registers, a list of 1,742 workers hired since factory startup was assembled using the files of the Italian National Social Security Agency (digitalized in 1974 and perused manually by one of the Authors for the previous period). To date, follow-up for mortality has been completed for the 580 male employees at work in 1961 or hired subsequently and who worked at SLOI for at least 12 months. Twenty-two (3.8%) were lost to follow-up. Mortality in this sub-cohort was compared with that of the population of the province of Trento, gathered since 1986 by the Institute of Statistics of the Trento Province. Excluding deaths occurring at age 90+ years, during the 1986-2016 period, deaths in the SLOI sub-cohort were 295 vs 229.0 deaths expected from age- and period-specific rates in the reference population (standardazied mortality ratio 1.29; 95%CI 1.15-1.44). In the absence of individual data, the possible contribution to the mortality excess by non-occupational risk factors cannot be estimated. Identification of causes of death is underway.

Objectives: the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures., Design: the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin., Setting and Participants: BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4)., Main Outcome Measures: environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation., Results: BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 µg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P., Conclusions: BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers.

Objectives: occupational exposure to vapours, gases, dusts and fumes (VGDF) plays an important role in the development and exacerbation of respiratory diseases. The aim of this study is to evaluate the possible association of occupational exposure to airborne pollutants and chronic respiratory diseases., Design: multicase-control study., Setting and Participants: cases of chronic respiratory diseases and controls from the Italian multicentric study Gene Environment Interaction in Respiratory Diseases (GEIRD)., Main Outcome Measures: the occurrence of rhinitis, asthma, chronic bronchitis/chronic obstructive pulmonary disease (COPD), asthma severity, spirometry data, exhaled nitric oxide (FeNO) were examined in relation to chronic and acute occupational exposures to airborne pollutants using multiple regression models., Results: 2,943 subjects were enrolled in the study. Regularm exposure to VGDF was associated with a higher prevalence of chronic bronchitis/COPD (OR 1.40, 95%CI 0.98-1.99), especially in those also having asthma (OR 1.80, 95%CI 1.14-2.85), a lower prevalence of remittent asthma (OR 0.53, 95%CI 0.29-0.96) and, in those with asthma, an increased activity of the disease (severity score) (OR 1.77, 95%CI 1.20-2.60). No associations were observed between occupational exposure and prevalence of rhinitis, spirometry and FeNO data. Finally, an association was found between acute exposure to airborne pollutants (occupational and non-occupational) and the respiratory diseases investigated, in particular active asthma and asthma associated chronic bronchitis/BPCO., Conclusions: these data confirm a significant role of occupational exposure to airborne pollutants on respiratory health, underlying the importance of workplace exposure prevention, in particular for more susceptible subjects, as those with respiratory diseases.

It is well known that the prevalence of respiratory allergies has increased over time. At the same time, climate change has become part of our everyday life. The resulting question is whether this 'allergic epidemic' is linked to this aspect. It is assumed that the causes of the increase of respiratory allergies are mainly related to environmental factors and lifestyle: first, the improvement of social and health conditions and related hygiene hypothesis; secondly, lifestyle change and anthropogenic activities, which have caused an alteration in the balance normally existing between soil, water, and atmosphere, giving rise to the phenomena of climate change. In fact, it has been demonstrated that they can influence beginning, duration, and intensity of the pollen season, as well as the allergenicity of pollen. The consequence is both an increase in frequency and intensity of allergic symptomatology in subjects previously affected by allergy, and a promotion of the sensitization of the airways to allergens present in the atmosphere in predisposed subjects. Several intervention strategies aiming to mitigate climate change and reduce anthropogenic emissions and, consequently, respiratory allergies are possible and can be implemented on an individual and social level. It follows that the allergist cannot solve the problem of the progressive increase of respiratory allergies on his own. Anyway, his role can have both clinical and educational purposes with a special commitment to reduce health impact due to environmental risk factors. KEYWORDS: respiratory allergies; allergenic potential of pollen; climate change; pollution.

A recurrent topic in the debate on the mandatory immunisations, invoked by doctors, politicians, and parents, is the need to protect the right of immunocompromised children to attend preschool and school without taking serious risks. Data and evidence-based information can greatly reduce excessive fears and unreasonable emotional reactions. This paper presents many reasons for reassessing the issue of the school attendance of immunocompromised children in a more balanced perspective both in terms of absolute risk and of risk related to other common circumstances involving greater comparative risks. The whole community, the immunocompromised subjects, and their caregivers must be educated to face these circumstances every day, with measures and behaviours largely implementable by motivated and adequately informed people. Even physicians - and even more public health doctors - are called to take the responsibility to inform people in a balanced way, and to educate to implement the many evidence-based actions that can protect health, including protection from infectious diseases and their complications, with a commitment consistent with the potential of the available measures.

Pertussis vaccination has made an important contribution to the reduction in incidence of the disease, but internationally pertussis reawakens, even in highly vaccinated population groups. This resurgence seems to be attributable to various reasons: non-optimal efficacy of the vaccine; fairly rapid decay of protective antibody titers in part of the population and above all their inadequacy in preventing infections and transmission of the pathogen also from infected subjects; selective pressure of extensive vaccination with emergence of mutated resistant strains; substantial impossibility of obtaining a herd effect with the vaccines which are available nowadays. The present work analyses the state of scientific knowledge and illustrates various topics that may challenge a prevention based only on the paediatric vaccine obligation using a hexavalent vaccine. Public health strategies must be rethought, considering also different solutions that aim to fight the disease in a more targeted and potentially more effective way, avoiding major damage to people at greater risk. A currently tested strategy is the vaccination of pregnant mothers, but the experimentation of solutions less interfering with the bacterial ecology could be also considered; these solutions may only aim at avoiding major damage to subgroups at greater risk and should be integrated with initiatives to improve surveillance systems, microbiological diagnosis and lifestyle-based prevention.

OBIETTIVI: descrivere, nella ASL 21 di Legnago (VR), l'andamento di alcuni indicatori sanitari tra il 2009, anno precedente all'avvio di un progetto triennale per la gestione integrata dell'assistenza al paziente con diabete mellito di tipo 2, e il 2012, ultimo anno del progetto. DISEGNO: studio longitudinale trasversale ripetuto. SETTING E PARTECIPANTI: tutti i pazienti diabetici di tipo 2 della ASL 21, identificati nei database aziendali (in base a esenzioni per patologia, accessi al servizio diabetologico, consumo di farmaci antidiabetici e strisce per la determinazione della glicemia) e nelle cartelle cliniche dei medici di famiglia. PRINCIPALI MISURE DI OUTCOME: numero di test diagnostici e di follow-up erogati, consumo di farmaci, prestazioni specialistiche, accessi al pronto soccorso, ricoveri e mortalità. RISULTATI: nonostante un calo generalizzato (-3,1%) nei test erogati dalla ASL 21 ai suoi assistititi nel periodo 2009-2012, l'analisi ha documentato un marcato aumento per gli esami previsti nella gestione del diabete, quali curve da carico glicemico (+104,3%), emoglobina glicata (+19,0%) e microalbuminuria (+296,1%). I soggetti identificati come diabetici sono aumentati da 8.084 nel 2009 (5,2%) a 9.221 nel 2012 (5,9%). Sono stati osservati aumenti nella prevalenza di pazienti visitati presso un servizio diabetologico (dal 22,6% al 39,0%), nonché negli utilizzatori di metformina (dal 28,0% al 37,5%), insuline (dal 13,5% al 18,3%) e incretine (dall'1,4% al 9,0%). Il consumo di sulfaniluree è, invece, calato (dal 49,9% al 40,8%), come anche l'erogazione di alcune prestazioni specialistiche, gli accessi al pronto soccorso e i ricoveri, mentre il tasso di mortalità è rimasto stabile (29,6 decessi x1.000/anno). CONCLUSIONE: durante il periodo di implementazione del progetto sembra essersi verificato un aumento della sensibilità diagnostica e una maggiore presa in carico del paziente diabetico. Anche se la natura osservazionale dello studio non consente di dimostrare una relazione causa-effetto, i risultati sembrano supportare l'ipotesi che la gestione integrata della patologia migliori l'appropriatezza dell'assistenza.

Objective: To evaluate trends and association between antibiotic consumption and resistance during an eight-year period, from 2006 to 2013., Design: Prospective multicenter study., Setting and Participants: Intensive Care Units (ICUs) participating in the four editions of the Italian nosocomial infections surveillance in the ICU Network (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva, SPIN-UTI project)., Main Outcome Measures: The isolation density of selected species of microorganisms, antibiotic resistance rates (RRs), incidence density of resistant isolates and antimicrobial usage density were calculated., Results: RRs of carbapenem-resistant Acinetobacter baumannii, of carbapenem-resistant Klebsiella pneumoniae, of third-generation cephalosporin (3GC)-resistant K. pneumoniae and of 3GC-resistant Escherichia coli showed significant increasing trends (p ≤0.001). The consumption of each antibiotic class varied with years, although not significantly. Significant strongly positive correlations were detected between RRs and antibiotic consumption., Conclusions: The present study describes high RRs and increasing trends of resistant microorganisms and highlights the need for continuous comprehensive strategies targeting not only the prudent use of antibiotics, but also infection control measures to limit the epidemic spread of resistant isolates.

Aim: to describe the mortality risk for all causes and chronic diseases among people living in the industrial district of Viadana (Mantua), where wooden furniture factories producing formaldehyde and wood dust are situated., Design: mortality for the years 1996-2005 among residents in the municipalities where the industrial plants are located (exposed areas) was compared with the mortality among people living in the areas without plants (non-exposed areas)., Main Outcomes: standardized mortality ratios (SMR), using as reference the total population of the Province of Mantua., Results: overall mortality risk was slightly higher in the non-exposed areas and in the district of Viadana than in the Province of Mantua. Mortality risk for all cancers in the exposed areas was lower than in the Province of Mantua (SMR=0.93; 95% IC 0.87-0.99). Mortality for prostate cancer was significantly increased in the exposed areas compared to non-exposed areas (RR=1.83; 95% IC 1.08-3.09) and to the Province of Mantua as a whole (SMR=1.39; 95% IC 1.06-1.79). Mortality maps suggest a higher mortality risk for prostate cancer, mainly among exposed areas. An excess of mortality for leukaemia (non-statistically significant) and for respiratory diseases (statistically significant) was found in Gazzuolo and Sabbioneta, both located in the exposed area., Conclusion: no statistically significant excess risk of mortality for cancer of upper aerodigestive tract was found among residents in municipalities where wood dust and formaldehyde producing factories were active. The increased mortality risk for prostate cancer and leukaemia needs to be deeply analyzed.

This article deals with the problem of restoring and repairing the supply and distribution of drugs, a vital service damaged by long-term conflicts. During the post-war situation in Bosnia the Authors have been actively involved in the implementation of the Drugs Management Programme whose principal aims were as follows: 1) rationalise the arrival and storage of new drugs; 2) utilise efficiently the stocks of drugs and medical materials at hand; 3) cope with the steady post-war decrease of humanitarian aid drug donations; 4) eliminate the large quantities of expired or inappropriate drugs. The experience stresses the need that all EU countries adopt as far as possible the strict WHO guidelines in their donations to countries in emergency situations. However a very flexible organisation should be set up immediately after the conflict in order to tackle all the problems that, no doubt, will appear in the aftermath of a war.

The EC Respiratory Health Survey (ECRHS) design is presented: the survey aim is to estimate asthma prevalence and risk factors distribution in the various European countries population. In Italy three centres are involved: Pavia, Turin and Verona. EC Health Respiratory Survey is an international two stages cross-sectional survey on probability samples of general population aimed to asses asthma prevalence in different countries. In the first stage a random sample was sent a Screening Questionnaire by post; in the second stage a subsample was invited to clinical centres in order to undergo lung function tests, allergy tests and a standardised clinical interview. The analysis of the response pattern in Italy shows that both in stage 1 and in stage 2 a selection bias overestimating real prevalence is present. Some methodological issues concerning the design of cross sectional surveys are addressed.

A high prevalence of minor psychiatric symptoms is present in the community. When observed at the general practice level, the symptomatology has by this time usually developed to such a degree to induce help-seeking and has acquired the status of an evident clinical and health problem. Hence, general practice attenders constitute a relevant intermediate area of research for psychiatric epidemiology placed between community surveys and surveys based on contacts with specialistic services. Psychiatric morbidity has revealed itself as a major clinical problem for general practitioners, since the large majority of patients with emotional distress problems are recognized and treated in general practice services. The present paper reviews the major international studies on the topic and recent studies put forward in Italy by the Psychiatric Epidemiology Research Unit of Verona University.